Every Emergency Department Should Stock Two Types of Supraglottic Airways: Laryngeal Tube Rescue After Failure of a Laryngeal Mask Airway: A Two Case Series.

BACKGROUND: Supraglottic airways (SGAs) are critical rescue devices in emergency airway management and provide effective oxygenation in most failed intubations. Current airway algorithms recommend availability of a supraglottic airway but do not distinguish between device classes. Laryngeal mask-style SGAs create a perilaryngeal seal over the glottic inlet, whereas laryngeal tube-style devices create a hypopharyngeal seal with dual cuffs. Because these devices seal in different anatomic locations, they may fail for different reasons. CASE REPORTS: We report two emergency department cases in which ventilation failed with a laryngeal mask-style SGA but succeeded immediately after placement of a laryngeal tube-style device. In the first case, a patient with previously unrecognized Klippel-Feil syndrome developed hypoxemia after failed intubation and ineffective ventilation through a laryngeal mask-style device; oxygenation was restored with a laryngeal tube, avoiding surgical airway. In the second case, a patient with penetrating neck trauma could not be ventilated with a laryngeal mask-style device despite repositioning, but ventilation was immediately successful with a laryngeal tube, allowing controlled intubation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: These cases suggest that supraglottic airways are not interchangeable and that access to more than one device class may provide an important safety margin during airway rescue.